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07/22/2015

PTs Talk PT - Michael Fox of Star Physical Therapy

Michael Fox, PT, SCS, MTC, talks balance (and more)
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Michael Fox, PT, SCS, MTC

Owner, Star Physical Therapy (starphysicaltherapy.com), New York, NY




CSMi: WHAT LED YOU TO START YOUR OWN PRACTICE?

MICHAEL FOX: I started working at Lenox Hill Hospital after graduating NYU’s PT program and got great exposure to a variety of conditions and postoperative procedures which gave me a great foundation for my next position, working in one of the premier sports medicine centers in the country- NISMAT. My current partner Ben Gelfand was running the PT department at NISMAT at the time. He set me up with an interview with late Dr James Nicholas who was very influential in guiding my practice insisting that I have sound reasoning behind my treatments choices. He encouraged me to emphasize the study of the spine and core as a solid foundation in my study of sports medicine. He was ahead of his time, and I am grateful for the time he spent with me and for the knowledge he imparted.

WHAT ARE THE MAIN CHALLENGES YOU'VE ENCOUNTERED AS SOMEONE RUNNING YOUR OWN PRACTICE?

When we first opened STAR in 1991, my partner and I worked long hours, emphasized great quality care, had talented and dedicated staff and built strong professional relationships that kept patients seeking our care. In the 90s, this was enough to sustain a healthy growing practice. Now, the biggest challenge is to make sure that we as managers of a busy practice align ourselves with payors that respect our quality. Expenses rise every year--you can count on it.
Rreimbursement for our services either remains static or diminishes. The challenge is to create new relationships with payors that keep you in the black, and dropping the ones that put you in the red.

WHY DID YOU CHOOSE TO FOCUS ON THE SPORTS ASPECT OF PHYSICAL THERAPY, RATHER THAN BEING AN “ALL-SERVICE” PHYSICAL THERAPY OPERATION?

We didn’t! Ben and I were the first private practitioners in NYC to be awarded the distinction of Sports Certified Specialists (SCS). This did two things: it allowed us the opportunity to work with some of the top sports medicine doctors in the country. It also allowed me to work on the sidelines for local rugby teams which I took full advantage of. Also, our training at NISMAT gave us a strong foundation in sports medicine, but also a very open-minded approach to patient care. While simultaneously caring for New York's top pro athletes, Dr. Jim Nicholas felt that helping patients get back to playing billiards and playing cards was sports medicine. This encouraged me to take what I learned working with athletes and expand it to other populations. I certified in manual therapy through The Paris Institute, which gave me great insight into biomechanics and a new skillset to address joint dysfunction in a logical fashion. My partner went on to certify in ART. We now have a practice that has multiple Centers Of Excellence: Sports, Spine, Hand (we have a thriving hand practice with certified Hand Therapists) and Hip. We also have programs that address balance problems, post pregnancy back dysfunction, preoperative joint replacement, golf as well as Yoga and Pilates. So although our foundations are in sports, our applications are much more eclectic.

HOW HAS THE ROLE OF THE PHYSICAL THERAPIST CHANGED WITH RESPECT TO CONCUSSION DIAGNOSIS, TREATMENT, AND MANAGEMENT?

I have been functioning in the role as Head PT for the NYAC Men's Rugby Team for the past 15 years. I have also traveled with the Eagles Men's National Rugby team in the role as Team Physical Therapist. STAR's staff works the sidelines for NYAC's games which puts us in the role of treating and managing concussions on a regular basis. It is vital to stay on top of new research that comes out almost weekly now in order to effectively help our athletes with head trauma. It is really helpful to have a team of concussion specialists to rely on for diagnosis, treatment and return-to-play guidance. USA’s annual Rugby Medicine Symposium and NYU’s annual concussion symposium are great sources of up to date information.

ARE YOU INVOLVED IN ANY PRE-SEASON BASELINE CONCUSSION TESTING FOR ATHLETES?

Before each season we do a SCAT 3 and an in-depth concussion history on all players for the NYAC Men’s Rugby Team. We are now also doing a King-Devick Concussion test which measures the speed that the eye can follow specific directions on a chart. We use this pre-season (normal) data to help determine return-to-play time frames after a player sustains a concussion.

WHAT ROLE DOES BALANCE TESTING AND BALANCE-RELATED THERAPIES PLAY IN YOUR PRACTICE? WHAT ARE THE TOOLS AND TECHNIQUES YOU USE IN THIS AREA, AND WHAT TYPE OF PATIENTS IS BALANCE-RELATED TREATMENT MOST EFFECTIVE?

Balance is a part of almost everyone’s treatment at STAR. All older patients do balance work because balance declines with age and this is a major reason for falls in our elderly population. Athletes with ligament injuries, especially ACL, have proprioceptive deficiencies that need addressing bilaterally to minimize chances of future knee injuries. Balance training gives multiples in benefits for a single exercise: it strengthens the muscles of the spine, hip, knee and ankle/foot, improves ROM and stability at the ankle, as well as improving lower-extremity proprioception. All of these can be enhanced working balance barefoot.

STAR has a Balance Program that incorporates our HUMAC Balance system for evaluation and treatment purposes. Patients appreciate the feedback they get from the computer. We also spend a good deal of time on the balance board and the hip machine.

WHAT HAVE YOU FOUND DIFFERENT ABOUT THE JOB THAN WHAT YOU EXPECTED WHEN YOU WERE A STUDENT PREPARING FOR THIS CAREER?

I entered the field as a second career so I was older and knew that this is what I wanted to do with my life. Early on, I read everything I could related to the clinical side of patient care. I couldn’t imagine that, someday, I would find practice management as fulfilling as the practice of diagnosis and treatment as I do now.

WHAT ADVICE WOULD YOU GIVE A PHYSICAL THERAPIST WHO IS CONSIDERING LAUNCHING THEIR OWN PRACTICE?

I think the days of starting and operating small independent private practices are going to be overshadowed by large hospital organizations that will manage where referrals go--quite possibly into their own satellite clinics. It will be harder (maybe impossible) for small clinics to negotiate acceptable rates with insurance companies. So, one angle would be to develop a niche that you are passionate about and that people will pay cash for even though they have other options that would be covered by insurance. Another option would be to align with a larger organization once you are up and running.

WHAT ADVICE WOULD YOU GIVE TO A STUDENT WHO IS CONSIDERING A CAREER IN PHYSICAL THERAPY?

If you are passionate about the field it will be the best job you could imagine. There will always be room for creative people willing to apply themselves to benefit their patients. If you are not excited by what you have seen of the field while volunteering and in school, look for something else.

IF YOU COULD SHARE ONE TRICK OF THE TRADE YOU’VE LEARNED IN YOUR CAREER WITH A PEER, WHAT WOULD IT BE?

No tricks. Do right by your patients, your staff, and your referrals and you will have a fulfilling career.

WHAT ONE MOMENT IN YOUR CAREER TO YOU LOOK BACK ON AS THE MOST IMPORTANT ?

My earliest decisions were the most important in guiding me to where I am now. Accepting the position at NISMAT (my second job as a PT) and certifying in manual therapy were most influential in giving my practice direction.


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